WhatWho has not at some time had absurd, illogical, even clearly immoral thoughts and contrary to their own principles? Who has not experienced a strange and totally crazy idea intruding into his consciousness? Well, scientifically speaking, less than 20% of people. And yes, indeed, a figure that at first glance seems striking, but it is what research that delved into this matter has systematically found.
The vast majority of us experience from time to time the presence, in our focus of attention, of crazy ideas, incongruent and even contrary to our values. This is totally normal. What is not normal and can cause a lot of suffering is worrying about these thoughts and trying to control them. In fact, this is one of the hallmarks of Obsessive Compulsive Disorder (OCD).
One of the distinctive and most pitiful characteristics of OCD is the impairment it entails at the level of thought. Those who suffer from the condition usually suffer a lot as a result of what they think, how they think and the great effort they make to control their thinking. Although this characteristic has multiple causes, one of the most notable is the process we refer to here, generically known as “dysfunctional metacognitive processes” or “inadequate cognitive control strategies.”
What is normal
Most people, more than 80% according to research, report experiencing absurd thoughts, sometimes contrary even to their own principles. They are called “intrusive thoughts” because of the quality they have of intruding into the person’s consciousness, in an involuntary and unconnected way with other thoughts and activities. Let’s look at some examples of intrusive thoughts frequently reported by normal subjects:
- Jump from a high window or balcony.
- Pushing someone under the train, car, bus.
- Hitting and hurting someone while driving and not realizing it.
- Not having properly closed the door of the house when leaving.
- Leaving home without warning, escaping.
- Sexually assault someone.
The experience of intrusive thoughts is not only not considered pathological but, furthermore, it is estimated that it may be a healthy and adaptive phenomenon. It could be an important part of the exquisite and distinctive human creativity, of the ability to generate novel solutions to problems. Perhaps many of our cultural achievements have one of their roots in intrusive thoughts.
If you value articles like this, consider supporting us by becoming a Pro subscriber. Subscribers enjoy access to members-only articles, materials, and webinars.
What is not normal
Worrying about intrusive thoughts and therefore trying to control or prevent them; that’s not healthy. And as we already anticipated, an important part of the pathology that we observe in OCD lies in this process. We will dedicate ourselves to this in more detail below.
As we already know, human beings are the only ones with the ability to produce what, in the strict sense, we call thoughts. We are not only conscious, but we are also aware that we are conscious, that is, we know that we know. So, for example, when we remember the people we love, we realize that we become happy or that we miss them; which can, for example, lead us to avoid or encourage some thoughts.
Worrying about intrusive thoughts and therefore trying to control or prevent them; that’s not healthy
Let’s notice that, in the previous example, we have two types of thoughts. First, thoughts about the people I love, my girlfriend, my son, my friend; ideas that provoke in me feelings of tenderness and pleasure. Second, the thought that “thinking about such people provokes feelings of tenderness in me”, that is, I think about what I think, I know that thinking about my girlfriend gives me pleasure. This second thought is called metacognition, it is thinking about thinking. Furthermore, metacognition can lead to specific efforts to think or not think about certain content.
Continuing with the example, I can try to concentrate more on the memories related to my girlfriend because it gives me pleasure or, on the contrary, if it makes me miss her too much and therefore suffer, I can try to distract myself with a movie so as not to think about her. .
All of this is perfectly normal and healthy. Metacognition, thinking about thinking, is not a pathological or novel phenomenon. However, like many adaptive characteristics, it can in some cases turn against us.
Some people feel responsible for what they think or have the mistaken idea that thinking something repeatedly makes it more likely to happen. From a cognitive variable point of view, these people have exaggerated dysfunctional schemas.
The “thought-action fusion” scheme is a belief by which people equate thinking with doing.
An “exaggerated personal responsibility scheme” for thinking consists of the belief that having an idea about some dangerous event that could occur transforms the person into an agent responsible for preventing the unwanted event as well as the potential consequences if it occurs. the event took place. So, for example, if when I leave work, I think that someone may have left the electric oven plugged in, which in turn could cause a fire; So not going to check the condition of the oven makes me responsible if such an event were to take place. That way, I feel compelled to return to my work and do the necessary verifications.
Of course, in patients with OCD this does not happen in isolation but repeatedly and frequently. In this case, the intrusive thought “the electric oven could be on and cause a fire” combined with an exaggerated personal responsibility scheme results in high verification behaviors, that is, it would be verification OCD.
Another very characteristic example is the “thought-action fusion” scheme. It is a belief by which people equate thinking with doing. This can in turn take two forms. On the one hand, the thought-action fusion scheme leads the person to consider it probable that they will perform a behavior if they think about it.
So, for example, when seeing a sharp knife, a person suffering from OCD has an intrusive thought “what if I went crazy and stuck it at my husband.” Next, the woman thinks “I am a potential murderer, I can kill someone,” which leads her to become anxious and take measures to prevent the hypothetical homicide. Thus, the woman in the example could avoid coming into contact with knives, scissors or other sharp objects.
Trying to ban a thought only increases it. Therein lies a large part of the vicious circle in which those who suffer from OCD are trapped.
A quite particular example of this type of case is the one that has spread in recent years under the name “homosexual OCD”, an unhappy expression used to refer to people who become obsessed and have pathological doubts regarding their sexual orientation. . These are heterosexual people who have some intrusive thought like “what if I happen to look at men in the locker room” or “what if I start liking my coworker.” Then, from such intrusive thoughts, the subject, male in our example, makes an assessment of his own thoughts, he says to himself “if I think that, I could be homosexual”, which makes him anxious and leads him to seek to corroborate his sexual orientation.
And it is with such verification behaviors that the circle of pathology is closed, since the individual begins to look at other men, particularly some of their sexual characteristics and very frequently through the use of pornographic videos or photographs with the aim of corroborating who is not attracted. However, in the process he becomes anxious, loses some of his self-control, and when he sees himself looking at other people of the same sex he says something like “and if I’m looking, it’s because I must like it.” That is to say, the very act of verification is evaluated as dangerous and indicative of a homosexual orientation, which restarts the circle and ends up reinforcing the pathology.
A widely observed variant of the recently mentioned scheme is called “thought-action moral fusion” in which, as its name indicates, the negative assessment of intrusive thought has a moral connotation. Thus, for example, a person who suffers from OCD has some spontaneous sexual fantasy with a person he knows, after which he says to himself “what do I think… I am immoral”, which is why he feels guilt, discomfort and from that, Try not to have similar sexual fantasies.
Unfortunately, it is unlikely that prohibiting thought will be achieved; in fact, the opposite is usually achieved; The thought that is being avoided tends to increase with the consequent escalation of distress for those who suffer from OCD.
Inappropriate control strategies and their treatment
In the previous point we have tried to briefly describe one of the most characteristic features of OCD, considered to have etiological value for the disorder. One of the common denominators of the dysfunctional schemes referred to is the excess of thought control that fails to operate. Whether due to an exaggerated scheme of personal responsibility or one of thought-action fusion, the patient with OCD carries out a cognitive process that we can summarize in three steps:
- You have an intrusive thought.
- He negatively values the previous intrusive thought, which causes him emotional discomfort.
- Try to control or prevent the appearance of intrusive thoughts or their consequences in order to alleviate their discomfort.
But contrary to the intentions of the person with OCD, the strategies used to control and prevent the appearance of intrusive thoughts fail, in the worst sense. Not only do they fail to eliminate intrusive thinking, but in the long term, they increase it.
Simply put, trying to ban a thought only increases it. Therein lies a large part of the vicious circle in which those who suffer from OCD are trapped. Try to “not think” about certain contents, but this leads to an increase in them; which brings greater discomfort, but also a greater effort to “not think” that results in a new escalation of the contents that one wants to avoid. In short, a vicious circle that can reach very high levels, with the consequent suffering and impact on health and quality of life.
The treatment
As can be deduced from the aforementioned research on inadequate control processes in OCD, it is necessary for patients to learn not to fight their intrusive thoughts. To do this, the approach…